The Australian arm of the multinational pharmaceutical company GlaxoSmithKline (GSK) will work towards publicly declaring how much it pays individual doctors and other healthcare professionals.

As a first step in this direction, the company has announced that it will declare the total value of payments that it makes to healthcare professionals, starting with the release next month of the 2010 data. Included will be all grants, donations, consultancy fees and sponsorships made for research grants, advisory committee work and educational projects.

Deborah Waterhouse, general manager of GlaxoSmithKline Australia, said the disclosure was part of a global initiative by GSK, with the Australian company one of the first to have the data ready to publish.

In an interview, Waterhouse said she was personally committed to eventually having the company declare payments on an institutional and individual basis. However, she expected this would be a long and complicated process, given privacy laws.

“I’m a huge advocate of transparency,” she said.

While GSK may be the first pharmaceutical company in Australia to disclose its total payments to healthcare professionals, the wider context is that our reporting standards lag those of other countries.

Advisers to drug companies in the UK are required to declare the arrangement whenever they write or speak in public on any issue relating to the company, under a new code of practice from the Association of the British Pharmaceutical Industry, according to this recent BMJ report.

In the US, the public already has access to some information about payments to individual doctors (as shown by the Dollars for Docs database compiled by ProPublica), and will gain even greater access as a result of the Physician Payment Sunshine Act, which requires drug, biologic, and medical device manufacturers to report certain gifts and payments made to physicians from 2013.

Meanwhile, the Indian Medical Council has banned doctors from receiving gifts, travel and hospitality from pharmaceutical or allied healthcare companies, and says doctors also must not endorse any drug or product in public.

It is telling that a major company has taken the lead in pushing the agenda in Australia, where public institutions have been slow to respond to concerns about the impact of ties between companies and health professionals and policy advisers.

When I wrote this article for Australian Prescriber last year, titled “Can sunshine cure the unhealthy entanglement of industry and health care?”, the National Health and Medical Research Council was promising to soon release a discussion document that would canvass ways of ensuring researchers, universities, other research institutions and healthcare practitioners manage conflicts of interest more effectively. We’re still waiting on it …

Meanwhile, ethical campaigners have welcomed GSK’s move. Dr Ken Harvey, adjunct senior lecturer in the School of Public Health at La Trobe University, said: “GSK, to their credit have taken the lead in a number of things, including opening up patents and helping with third world diseases, and I’d be happy to commend them for it.”

Dr Peter Mansfield, an Adelaide GP who heads Healthy Skepticism, an international group campaigning against misleading drug promotion, said GSK’s announcement should be credited as a small step in the right direction.

However, he argues that open disclosure should not been seen as the solution, and that it would be better to end the financial entanglements between industry, research and practice.

Mansfield also called on the AMA, medical boards, universities and professional groups to ensure health professionals are better educated about the evidence showing the harmful impact of financial entanglement with industry. “What our profession needs to do is to learn the literature on this issue,” he said.

Interestingly, the vice-president of the AMA, Dr Steve Hambleton, has come out in favour of individual disclosure when significant payments are involved, and commended moves towards greater transparency.

“It will drive everyone nuts if the drug companies are printing that we bought a sandwich for Dr X on X date, but clearly if someone is getting a substantial payment, then it is important for everyone to know,” he said in an interview this morning.

“The frontline medical troops also need confidence that the opinions they’re getting at international and local meetings are reliable and independent.”

Maybe the times really are a changin’. But it’s no revolution — more like one baby step at a time …

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(former drug company representative www.kimberlycheryl.net ) 2009

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